Diagnostic yield of Virtual Bronchoscopic Navigation (VBN) guided Bronchoalveolar Lavage (BAL) in peripheral pulmonary infections: a prospective pilot study

Abstract Background: Bronchoalveolar lavage (BAL) is a key diagnostic tool in evaluating pulmonary infections and infiltrative lung diseases. However, conventional BAL relies on operator-dependent segment selection, potentially limiting diagnostic yield in peripheral pulmonary lesions. Virtual Bronchoscopic Navigation (VBN) has been shown to improve localization in biopsy procedures but its role in guiding BAL remains unexplored. Objectives: To evaluate the diagnostic yield of VBN-guided BAL in patients with clinical features of pulmonary infection having peripheral pulmonary lesions on radiology. Methods: This prospective observational pilot study included 50 adult patients with features of pulmonary infection having peripheral pulmonary lesions on radiology. All patients underwent VBN-guided BAL. Samples were analyzed using microbiological, molecular, and cytological techniques. Diagnostic yield and impact on clinical diagnosis were assessed. Results: A definitive diagnosis was achieved in 42/50 patients (84%). Diagnostic yield was higher in immunocompromised patients (92.9%) compared to non-immunocompromised patients (80.6%), though not statistically significant (p=0.414). The final diagnosis differed from the initial clinical diagnosis in 62% of cases. Common diagnoses included bacterial pneumonia (36%), tuberculosis (28%), and fungal infections (16%). Conclusion: VBN-guided BAL demonstrates high diagnostic yield in peripheral pulmonary lesions and may significantly alter clinical management. Larger comparative studies are required to validate these findings.